Harmonizing Nursing Education in Europe: Disparities, System Challenges, and Implications for Bulgaria

Background: Nursing education in Europe has undergone substantial reform over the past two decades, primarily driven by the Bologna Process and European Union directives aiming to harmonise educational standards and facilitate professional mobility. However, growing evidence indicates that structural alignment has not fully translated into equivalent educational outcomes and competencies across countries. Methods: A scoping review was conducted following the Arksey and O’Malley framework and PRISMA-ScR guidelines. Three databases (PubMed, Scopus, and Google Scholar) were systematically searched for studies published between 2010 and 2025. A total of 1,492 records were identified, with 11 studies included in the final qualitative thematic analysis. Results: Significant heterogeneity was observed in curriculum structure (180–240 ECTS), clinical training requirements, and competency frameworks across European countries. Disparities were particularly evident in the implementation and quality assurance of clinical practice. In Bulgaria, key challenges include workforce shortages, limited clinical training capacity, underfunding, ageing student populations, and high emigration rates. Additionally, gaps were identified in the integration of evidence-based teaching, digital competencies, and interprofessional education. Conclusions: While progress towards harmonisation has been achieved, persistent systemic and functional disparities continue to limit educational quality and workforce mobility. Addressing these gaps requires integrated reforms combining educational innovation, health system investment, and targeted national workforce strategies, particularly in countries such as Bulgaria.